Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Thursday, July 10, 2008

More on our study

Okay, now that I've dealt pretty thoroughly with the limitations, what are we trying to accomplish and why do I think the limitations are acceptable?

First, in answer to C. Corax's question, yes, the evidence we have is that recording natural interactions isn't very disruptive. People quickly forget that they are being recorded, as far as we can tell, and behave normally. Obviously, that's difficult to prove, because it's considered unethical to record people without their permission. But experiments in which other assessments of interactions -- such as participant answers to questionnaires about the encounter, observations, and outcomes such as subsequent patient behaviors -- are compared in recorded and non-recorded encounters don't find any effect of recording per se. Anyhow, it's the best we can do. If you think doctors are on their best behavior when they are recorded, and that's different from how they normally behave, then you think that most of the time, they aren't really trying. And at least we're learning what their best is -- which, by the way, isn't necessarily very good.

We're actually finishing up one study as we start the new one, and we're trying to apply the lessons we've learned so far to our methods, our hypotheses, and our analyses. I can't get too far ahead on this blog -- we need to write up our results, get them peer reviewed, and publish them, and it's considered unseemly to say too much ahead of time, except for academic conferences. But I can tell you what we've already presented at conferences, and something about our questions and our methods.

The culture of the medical profession, and the wider culture too, I would say, awards a lot of prestige to physicians mostly because of their technical knowledge and skills. They are a kind of priesthood, sole possessors of arcane powers, and that's why they make the big bucks and your mother wanted you to marry one. In order to be admitted to medical school, you need top grades in science courses, and you need to do well on a test of scientific knowledge and aptitude. However, you don't need to study any humanities, and you don't need to be able to write a coherent sentence, let alone a paragraph. You can be a complete jerk as well, although most medical students I have known are nice people who want to do good by their patients as well as buy a horse farm some day, and some of them even have no interest in the horse farm. But it's not a qualification.

And that's a problem, because the effective practice of medicine is not achieved by technical skill alone. The most important skill, in fact, in my view (which is probably self-serving, but you're getting it anyway) is communication, in all its dimensions. Many people, including as a matter of fact many linguists, have a large part of their conceptual space occupied by the idea that the main function of language is representing reality -- that communication means using auditory symbols to create knowledge about concrete facts in the brain of the listener. We don't have to think about it very long to realize that this is only one of many functions of language, and it's not the most important function of doctor talk at all.

So we're trying to learn about how the talk between doctors and patients functions in myriad ways, and how those ways work together to create a complete encounter with whatever effects it has on people's subsequent well-being. More specifics to come.